Healthy Weight Management and Bariatric Surgery New Patient Forms

Before your first appointment, we ask that you complete a New Patient Health Analysis form, either online or through a PDF version that you can print and mail or fax to us.

Surgical Weight Loss

Please attend our in-person seminar or complete the online bariatric seminar before submitting the New Patient Health Analysis form. We will then call you to schedule an appointment with one of our bariatric surgeons.

Non-surgical Weight Loss

Please complete and submit both the New Patient Health Analysis form and the 3-Day Daily Food Diary form. We will then call you to schedule an appointment.

Online Forms

• New Patient Health Analysis
• 3-Day Daily Food Diary (only required for non-surgical weight loss program participants)

Below are PDF versions if you would prefer to complete paper copies:

• New Patient Health Analysis form
• 3-Day Daily Food Diary (only required for non-surgical weight loss program participants) 

Please mail or fax the paper forms to us before your first appointment:

Healthy Weight Management and Bariatric Surgery
Lancaster General Health
2150 Harrisburg Pike, Suite 300
Lancaster, PA 17601
Fax: 717-544-3935

Patient Guide

A PDF version of our Patient Guide is available here.